News: Lord Darzi sets out his vision for the NHS

To mark the 60th anniversary of the NHS, the government published the final report of Lord Darzi’s Next Stage Review of the NHS. The report identifies the coming “information age” as a key challenge for the NHS; but also puts its faith in technology as a way of meeting the challenge in the future.

The government’s Next Stage Review of the NHS has identified a new era of “information and connectivity” as one of the key challenges facing the NHS.

The final report of the 12 month review, led by Professor Lord Ara Darzi of Denham, says patients can find information more easily than ever before and that they expect to discuss treatment options with clinicians.

It also says they expect to provide feed-back on their experiences, while staff expect to work in “high quality” environments in which they are well trained and have opportunities to learn from each other.
“We need a more personalised NHS, responsive to each of us as individuals, focused on prevention, better equipped to keep us healthy and capable of giving us real control and real choices over our health and lives.”
In response, the High Quality Care for All report says patients should be given more information and choice, while NHS organisations are given more incentive to respond to their views and to drive up quality.

It also says a myhealthspace portal will be developed to give staff access to key systems such as NHSmail and to new quality and peer-to-peer services.

The NHS in the information age

High Quality Care for All was published to coincide with the 60th anniversary of the NHS on 5 July. It argues that there is still a “compelling” case for a tax-funded NHS that is free at the point of delivery. But it also says the health service is facing six challenges.

These are: rising expectations, new treatments, an ageing population, the changing burden of disease (from acute to chronic conditions), “the continuing development of our information society” and “the changing expectations of the health workplace.”

It notes that three quarters of British households will have broadband internet access by 2012, and that this will have a “profound” impact on health and health care. “People are able to quickly and conveniently find information about treatment and diseases in a way that was previously impossible,” it says.

“They are able – and want – to engage with others online, sharing information and experiences... and they want to reflect on what their clinicians have told them and discuss issues from an informed position.”

To meet these demands, High Quality Care for All argues that the NHS needs to provide more and better information on health, diseases and treatment options.
“We want patients to make the right choices for themselves and their families.”
The HealthSpace feature of the NHS Choices website will be developed to give patients access to their own health records and to allow them to add test results – in a move that echoes the arrival of platforms such as Microsoft’s HealthVault in the US.

Other features will allow people to register with a GP online and to see more information about the quality of NHS and social care services, including the views of other patients.

“We want patients to make the right choices for themselves and their families. So we will empower them to make informed choices. NHS Choices will publish clear information on the quality of care each service offered by every NHS organisation – across all settings of care,” Lord Darzi told a news conference to launch the report.

An NHS constitution

To underline its importance, a right to information will be included in the forthcoming NHS Constitution, a draft of which was launched alongside High Quality Care for All.

The constitution, which will not be legally binding, will also pledge that patients will be able to access their health records at any time and that these will only be used to manage their treatment in their best interests.

It reminds staff that they have a duty to protect the confidentiality of personal information they access, although it falls short of setting out any punishments for a breach. Meanwhile, the constitution proposes a number of patient responsibilities, one of which could be to feedback on any services they receive.

At the press conference, health secretary Alan Johnson said the constitution was a chance to “secure the founding principles of the NHS” while setting out both the rights and responsibilities of the public, patients and NHS staff.

New technology for NHS staff

Alongside new web services for the public, there will be new web services to help the people who work for the health service. The report outlines plans for a new NHS Evidence service to give them access to clinical and non-clinical evidence and best practice through a single portal managed by the National Institute for Health and Clinical Excellence.

Its final chapter also stresses the need to develop “high quality” workplaces and to make sure staff have “rewarding jobs that make a difference to patients.” It promises to give all staff access to personal development opportunities, training and support.

The report adds: “We will establish mystaffspace as a convenient, one stop portal for all staff. Through it they will be able to access the new NHS Evidence knowledge portal and get information on what high quality care looks like and how to deliver it, tailored to their own professional expertise and interests.

“They will also be able to access information on performance, their personal staff records, their credentials and a log of their learning and development.” It adds that NHSmail, which is moving to the Microsoft Exchange platform this autumn “will be there too.” 

Next steps

The latest ten year plan for the NHS comes with high-level backing. In a preface, Prime Minister Gordon Brown says it is a “once in a generation” opportunity to improve the NHS. “Over the past ten years, we have improved the basic standards of the NHS,” he says.

“[Now] we need a more personalised NHS, responsive to each of us as individuals, focused on prevention, better equipped to keep us healthy and capable of giving us real control and real choices over our health and lives.”

Primary Care Trusts will be expected to publish a strategic plan for implementing the review’s ideas next spring. They will be supported by a new operating framework for the NHS and a two-year spending settlement.

Meanwhile, the government is planning to move quickly on some of the other proposals in High Quality Care for All. It says that quality measures, including “patient reported outcome measures” or PROMs, will be in place as early as next year and that a small proportion of trust income could be linked to them by 2010.

It has promised to overhaul the Quality and Outcomes Framework that underpins payments to GPs and to devise incentives for strategic health authorities to encourage innovation, including the development of telemedicine services.

Meanwhile, to drive choice for people with long-term conditions, the Department of Health will publish patient prospectuses outlining the services that should be available to them by the end of the year. More than 15 million people with long-term conditions will get their own, personal care plans within the next two years. And the government will pilot individual budgets to give them more control over the services they receive.

These developments will depend on good IT to support choice and joint working. However, the report only briefly mentions the 150 GP-led health centres (or polyclinics) that have caused controversy. It says these should respond to local needs and priorities, so there can be no national blue-print for them.

"There are big challenges ahead but the NHS is clearly in much better shape than it was ten years ago,” said Mr Johnson. "These locally driven, clinically led plans show how quality of care will be raised right across the country. Quality of life will be improved and more lives will be saved."


The full text of the final report, High Quality Care for All: the NHS next stage review final report, can be found at: www.ournhs.nhs.uk, where there is also more information about the draft NHS constitution.
Find out more about NHSmail’s move to Microsoft Exchange or read how HealthVault is changing the face of healthcase in the US.